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MedPix Medical Image Database
COW - Case of the WeekCase Contributor: Johnathan l HadleyAffiliation: Eastern Virginia Medical School
MedPix No: 7688 - HistoryPt Demographics: Age = 64 y.o. Gender = manIntractable Nausea and Vomitting
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MedPix No: 7688 - EXAM & LABSNone available
Pancreatic adenocarcinoma
Image shows significant narrowing of the duodenal c-loop with concave bowing along the medial side
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Pancreatic adenocarcinoma
Placing the patient prone nicely demonstrates continued narrowing of the proximal duodenum with a normal diameter distal segment
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Pancreatic adenocarcinoma
CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum.
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Pancreatic adenocarcinoma
CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum.
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Pancreatic adenocarcinoma
CT of the abdomen shows a large mass in the head of the pancreas causing obstuction of the duodenum.
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Pancreatic adenocarcinoma
CT of the abdomen shows a large mass in the head of the pancreas; note the normal diameter distal duodenum.
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FINDINGSUGI images demonstrate marked narrowing of the proximal segments of the duodenum as well as massive distention of the stomach. The concave deformity along the pancreatic margin of the duodenum has been refferred to as the *reverse three sign of Frostberg.*CT confirms a mass in the head of the pancreas with compression of the duodenum. Note the preservation of the distal duodenal lumen.
DIFFERENTIAL DIAGNOSISWhat is your Differential Diagnosis?From the UGI only:- Pancreatic Adenocarcinoma- Chron*s- Infiltrating lymphoma- Duodenal wall hemorrhage- Severe post-bulbar ulcer- Duodenal Carcinoma
Diagnosis: Pancreatic adenocarcinomaDx Confirmed by: CT guided biopsy
DISCUSSION